Please use this identifier to cite or link to this item: https://doi.org/10.2174/1389200223666220425111931
Title: Elevated Urinary Tissue Inhibitor of Metalloproteinase-2 and Insulin-Like Growth Factor Binding Protein-7 Predict Drug-Induced Acute Kidney Injury
Authors: Akalya, K
Murali, TM 
Vathsala, A 
Teo, BW 
Low, S
Dharmasegaran, D
Koh, LP 
Bonney, GK
Hong, WZ 
Da, Y
Chua, HR 
Keywords: Acute kidney injury
Insulinlike growth factor binding proteins
antimicrobials
biomarkers
calcineurin inhibitors
drug-related side effects and adverse reactions
nephrotoxicity
tissue inhibitor of metalloproteinase-2
urinalysis
vancomycin
Issue Date: 1-Jan-2022
Publisher: Bentham Science Publishers Ltd.
Citation: Akalya, K, Murali, TM, Vathsala, A, Teo, BW, Low, S, Dharmasegaran, D, Koh, LP, Bonney, GK, Hong, WZ, Da, Y, Chua, HR (2022-01-01). Elevated Urinary Tissue Inhibitor of Metalloproteinase-2 and Insulin-Like Growth Factor Binding Protein-7 Predict Drug-Induced Acute Kidney Injury. Current Drug Metabolism 23 (3) : 223-232. ScholarBank@NUS Repository. https://doi.org/10.2174/1389200223666220425111931
Abstract: Background: Urinary tissue inhibitor of metalloproteinase-2 (TIMP2) and insulin-like growth factor binding protein-7 (IGFBP7) predict severe acute kidney injury (AKI) in critical illness. Earlier but subtle elevation of either biomarker from nephrotoxicity may predict drug-induced AKI. Methods: A prospective study involving serial urine collection in patients treated with vancomycin, aminoglyco-sides, amphotericin, foscarnet, or calcineurin inhibitors was performed. Urinary TIMP2 and IGFBP7, both absolute levels and those normalized with urine creatinine, were examined in days leading to AKI onset by KDIGO criteria in cases or at final day of nephrotoxic therapy in non-AKI controls, who were matched for age, baseline kidney func-tion, and nephrotoxic exposure. Results: Urinary biomarker analyses were performed in 21 AKI patients and 28 non-AKI matched-controls; both groups had comparable baseline kidney function and duration of nephrotoxic drug therapy. Significantly higher abso-lute, normalized, and composite levels of TIMP2 and IGFBP7 were observed in AKI cases versus controls as early as 2-3 days before AKI onset (all P<0.05); >70% of patients with corresponding levels above 75th percentile developed AKI. Normalized TIMP2 at 2-3 days pre-AKI predicted AKI with the highest average AUROC of 0.81, followed by that of composite [TIMP2]x[IGFBP7] (0.78) after cross-validation. [TIMP2]x[IGFBP7] >0.01 (ng/mL)2/1000 predicted AKI with a sensitivity of 79% and specificity of 60%. Conclusion: Elevated urinary TIMP2 or IGFBP7 predicts drug-induced AKI with a lead-time of 2-3 days; an oppor-tune time for interventions to reduce nephrotoxicity.
Source Title: Current Drug Metabolism
URI: https://scholarbank.nus.edu.sg/handle/10635/229159
ISSN: 1389-2002
1875-5453
DOI: 10.2174/1389200223666220425111931
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